ElderCare Online is dedicated to bringing you educational materials that help you to
enhance the quality of life your elderly loved one. We have begun working closely with
RSI, a leader in the development of health assessments, care plans and training materials
for frail elderly people and their caregivers.

RSI pioneered the idea of care management
for the "whole person" for elderly residents of assisted living facilities. In
the course of years of research, they developed a comprehensive training and care
management program that helps the elderly person stay active physically and mentally.

Together, ElderCare Online and RSI have tailored key components of the Caring Community
program to meet the needs of family caregivers. Over the next several months, we will be
presenting a new series of Skill Builders that focus on how caregivers  at home and
in residential facilities  can learn more about chronic conditions and improve
quality of care to their loved ones.

Introduction

Depression can be overcome, even though it disabling to daily functioning, happiness
and personal growth. People with depression can be helped to manage and stabilize the
disabling aspects of the condition and result in lives, which continue to have meaning,
personal growth and a sense of hope for the future. When frail elderly people are
depressed, they need to be helped to exercise as many personal choices and decisions as
they are able. Depression affects the whole person, body, mind and spirit. Because of
this, any plans of care for addressing depression, must include all these dimensions. The
final responsibility for overcoming depression rests with the frail elderly person. It is
unlikely that they can do this without the help of their caregivers. Depression so
extensively saps the energy and spirit of people that other resources are needed to
initiate recovery.

It is essential for caregivers to have the knowledge, skill and attitudes to address
the complexities which managing depression demands. This Skill Builder provides these
competencies for family caregivers. When caregivers possess the competencies to manage
depression, they will, in turn, be able to assist their loved ones to participate in their
own care. The mutual involvement of caregivers and their loved ones result in keeping
chronic conditions stable and enhancing the capacity for elderly people to successfully
address and manage their complex chronic physical, psychosocial and spiritual issues.

Maslow and Depression -- Meeting Your Loved Ones Needs

ElderCare Online and RSI emphasize promoting independence for frail elderly people.
But, when frail elderly have depression it requires that family caregivers know that they
can initiate actions to alleviate depression rather than expect the depressed person to
initiate their own self-help activities. Depression saps energy and decision-making
capacity. This leaves the depressed elderly person with only a small amount of energy to
help him/herself. The progress of recovery from depression is very often slow and results
are difficult to see. It is important for us to understand that depressed people can be
very self-centered. Knowing that the responsibility for improvement lies with the resident
can balance the, oftentimes, overwhelming responsibility which caregiving staff feels.

Physical/Biological Needs

Frail elderly, in particular, express depression through physical symptoms such as
headaches, backaches, backaches, stomach distress and constipation.Often medical
evaluation has determined there is no organic cause for these symptoms. Physiological
needs for balanced, nutritious meals, regular exercise and adequate, usual, uninterrupted
sleep are of utmost importance for health and improvement of depression. Depressed people
are often sedentary and have no motivation to move. Yet, exercise is known as a positive
force for relieving depression. Exercise activates serotonin and norepinephrine and
increases socialization, both known to enhance mental health.

Safety and Security Needs

Depression causes preoccupation with self, which may result in ignoring potential
environmental hazards. For whatever reason, depressed persons feel a very strong need for
a predictable, lawful, orderly world in which unexpected, unmanageable or other dangerous
things do not happen.

Love and Belonging Needs

A depressed person is at risk for not having his/her needs for love and belonging met
because of feelings of being a burden to others, of being no fun and spreading doom and
gloom to others.

Self-esteem Needs

Depression is often the cause or result of feeling inadequate as a person. Some people
with depression have been unsuccessful in handling their emotions alone. Feeling powerless
and giving up can result when repeated attempts to help their own depression have failed.
Depressed people have very negative opinions about themselves and feel very negative about
their future. They often cant describe one good thing about themselves and one thing
they enjoy. They minimize past achievements, concentrate on present failures even minor
ones. They feel they have nothing to look forward to. This leads to abandoning previous
roles because they cant be perfect and are afraid of failing. This leads to
withdrawal of activities.

Self-actualization Needs

Depression needs to be freed first because it is unlikely there is any energy left for
these creative self-expressions and personal achievements.

Talking to Depressed Elderly

How to talk to depressed elderly?

Listen. This is the most important. Give your time, full attention and listen.
Depressed elderly need an opportunity to put their feelings into words, to hear themselves
explain the problem and to know that you are hearing them and attempting to understand. Be
consistent and make fifteen minutes every day to spend alone with the resident.

Dont tell your own stories or the stories of people you know. Every elderly
persons depression is different. Your stories wont help. Your listening will.

Dont change the subject when your loved one pauses. Instead, try echoing his/her
words. For example, "You feel like youre disappointing your daughter when you
dont feel like going to her home for dinner." This encourages the elderly
person to say more about it.

Acknowledge the sadness, irritability or withdrawal

. This means that you should
respond to the feelings as much as to the words spoken. You might say, " Your sadness
makes you cry very often." If you name the feeling, your loved one will know that
he/she is being heard and understood. If your loved one doesnt agree with the way
you phrased it, she/he will explain the true feelings more carefully. Dont observe a
feeling and just leave. Distressed feelings need to be addressed when they are identified.

Do not judge your loved ones feelings.

Avoid saying "You shouldnt
feel that way." Instead, restate the feelings you think you are hearing to see if
that is actually what the person meant. Find out what is behind those feelings. For
example, "you are wondering whether your life could ever be as meaningful as when you
were in your 30s."

Resist giving advice.

The solutions that "take" are the ones that the
elderly person "owns" himself. If he thought of it, or believes that he thought
of it, he is more likely to follow through and make the change. We all dislike thinking
that someone else is running our lives. After letting your loved one express his concerns
and feelings turn the ownership for the solution to him. Ask him what he thinks would help
him to feel better or improve the situation that is problematic. Do discuss alternative
solutions to problems with him and adopt an approach that encourages him to generate his
own solutions. For example, "you need to discover what is best for you"
"Tell me what are the solutions and their pro and con".

Praise even minor accomplishments.

Make sure that your praise is an honest
acknowledgement of what progress has been made in any activity but particularly those that
you know will alleviate depression. Engage your loved one in conversations about previous
successes, what he does well and likes about himself.

Be honest and promote realistic expectations.

Unrealistic expectations can lead to
further failure and feelings of worthlessness. Help your loved one set goals that he/she
can meet. For example, "Two days ago you didnt think you could walk into the
dining room alone but today, you went there for breakfast".

Be patient and dont push the your loved one to respond.

Depression slows many
processes and oftentimes the elderly person needs time to formulate a response. Depression
can numb feelings and it may take more time to feel and to even put a name on the feeling.

Making Choices  My Own Decisions, Please

One of the major issues for a depressed person is his/her pervasive feeling of being
unable to control the people or events in his/her surroundings. This is sometimes called
"learned helplessness." Learned helplessness means that no matter how hard one
tries, one is unable to have any influence on others or on the environment. This results
in giving up making choices and trying to influence. Planning for, encouraging and
assisting residents to make as many choices as they are able and applauding their efforts
when they do can become a turning point in reducing depressions grip on the frail elderly
person.

Relieving Mild Depression  Special Activities

The prevalence of depression in frail elderly persons living in assisted living is
approximately 25% -- and perhaps higher in the home-bound population. The vast majority of
those with depression are experiencing a milder form of depression. All people with
depressive symptoms need medical care and treatment. When depression is mild and when the
people will not seek help from mental health providers, these alternative forms of
treatment or special activities may be helpful. These special activities impact on some of
the underlying reasons for depression in elderly persons such as loneliness, losses of all
kinds especially of health and functioning and lack of pleasurable activities each day.
People who are not trained as mental health specialists can do all of the special
activities discussed in this Skill Builder.

Music:

Relaxing and can help clear a persons mind so he/she can work through problems.

Creative outlet for expression of sad and empty feeling.

Relive positive experiences and bring forgotten meaning to current life.

Distractor from worries, disturbing thoughts or physical discomforts.

Music-how to:

You can conduct your own music therapy session by spending time with your loved one
listening to music, discussing it or drawing/painting while listening to the music.

Bring your loved one to a small live musical performance conducted by children or in a
park.

Quiet music at bedtime may aid sleeping.

Use music to aid exercise sessions or physical therapy.

Dance or move slowly to the music with your loved one

Pets:

Relieve loneliness and isolation.

Provide new and continued life meaning.

Rekindle new interests.

Stimulate resident to be more interested in his/her own personal care and feeding

Pets-How to:

Ask a young neighbor to regularly bring over a small pet, such as a cat, dog or rabbit.

Pet visitation programs in residential facilities.

Gardening:

Refocuses your loved one to "living things" and "new growth" rather
than "sick and old".

Sense if personal pride in creating something beautiful or edible.

For many, a continuation of an enjoyable lifetime interest.

Stimulus for related activities such as dried flowers, bird watching or cooking.

Gardening-How to:

Raised plant beds and growing seedlings under fluorescent lights.

Creating a Garden Club with neighbors or friends.

Psychodrama:

More acceptable and less anxiety producing substitute for psychotherapy.

Facilitates expression of all ranges of feelings.

Provides socialization opportunities.

Psychodrama-how to:

Group pantomime, acting out sections of plays or doing charades.

Using pictures or paintings to stimulate acting out moods and personalities of
characters seen in the pictures.

Role play a person that is admired.

Attending plays or viewing drama/humor on video and discussing portions.

Bibliotherapy:

Using selected readings (short stories and poetry) to stimulate discussion of feelings
and ideas that might be repressed.

Can meet the needs of small groups and individuals.

Reminiscence

Recalling and remembering past events, experiences, people and places has therapeutic
value.

Coping better with aging and death.

Sharing your recollections with others who will listen increases self-worth, either
current or past.